Atrial Fibrillation Ablation by Use of Electroanatomical Mapping: Efficacy and Recurrence Factors

Abstract

BackgroundRadiofrequency catheter ablation guided by electroanatomical mapping is currently an important therapeutic option for the treatment of atrial fibrillation. The complexity of the procedure, the several techniques used and the diversity of the patients hinder the reproduction of the results and the indication for the procedure. ObjectiveTo evaluate the efficacy and factors associated with recurrence of atrial fibrillation. MethodsProspective cohort study with consecutive patients submitted to atrial fibrillation ablation treatment guided by electroanatomical mapping. The inclusion criteria were as follows: minimum age of 18 years; presence of paroxysmal, persistent or long-standing persistent AF; AF recording on an electrocardiogram, exercise testing or Holter monitoring (duration longer than 15 minutes); presence of symptoms associated with AF episodes; AF refractoriness to, at least, two antiarrhythmic drugs, one of which being amiodarone, or impossibility to use antiarrhythmic drugs. ResultsThe study included 95 patients (age 55 ± 12 years, 84% men, mean CHADS2 = 0.8) who underwent 102 procedures with a median follow-up of 13.4 months. The recurrence-free rate after the procedure was 75.5% after 12 months. Atrial fibrillation recurred as follows: 26.9% of patients with paroxysmal and persistent atrial fibrillation; 45.8% of patients with long-standing persistent atrial fibrillation (p = 0.04). Of the analyzed variables, the increased size of the left atrium has proven to be an independent predictor of atrial fibrillation recurrence after the procedure (HR = 2.58; 95% CI: 1.26-4.89). Complications occurred in 4.9% of the procedures. ConclusionAtrial fibrillation ablation guided by electroanatomical mapping has shown good efficacy. The increase in left atrium size was associated with atrial fibrillation recurrence.

Safety and Effectiveness of a Novel Fluoroless Transseptal Puncture Technique for Lead-free Catheter Ablation: A Case Series

“…[21][22][23]27 Postoperative evaluation at an average of three months after ablation indicated a 27% rate of cardiac arrhythmia recurrence, in line with other studies. 36,37 In our center's experience, the technique described in this study improved procedural efficiency by approximately 15 minutes, which, combined with recent efforts to shift final sheath removal to the postanesthesia care unit, can lead to saving up to 30 minutes per procedure, allowing for more efficient procedure room turnaround between cases and reducing the necessity for staff to work overtime. Furthermore, our findings suggest that this fluoroless catheter ablation technique can be combined with operational efficiency initiatives without encumbering overall quality improvements.…”